Provider Demographics
NPI:1679688063
Name:POU-DELGADO, ISRAEL (MD)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:POU-DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 67 BOX 13130
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9501
Mailing Address - Country:US
Mailing Address - Phone:787-344-9882
Mailing Address - Fax:787-869-0580
Practice Address - Street 1:74 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3001
Practice Address - Country:US
Practice Address - Phone:787-344-9882
Practice Address - Fax:787-869-0580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24471Medicare ID - Type Unspecified
PRE97533Medicare UPIN